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Condensed Consolidated Statements of Cash Flows (USD $)
In Thousands, unless otherwise specified
 6 Months Ended
Jun. 30, 2013
Jun. 30, 2012
Cash flows from operating activities:    
Net income $ 124,585 $ 108,894
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 19,014 14,800
Accretion of contingent consideration liabilities 706 517
Stock-based compensation expense 15,092 13,089
Deferred income taxes 16,210 10,324
Changes in assets and liabilities:    
Accounts receivable (21,708) (10,532)
Prepaid expenses and other assets (2,251) (740)
Other assets 179 540
Accounts payable and accrued expenses (53,409) (57,733)
Income taxes payable (3,924) (3,312)
Long-term professional liabilities 11,962 6,720
Other liabilities 2,392 2,466
Net cash provided from operating activities 108,848 85,033
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (116,944) (64,869)
Purchases of investments (14,946) (14,113)
Proceeds from maturities of investments 2,263 10,800
Purchases of property and equipment (9,345) (6,821)
Net cash used in investing activities (138,972) (75,003)
Cash flows from financing activities:    
Borrowings on line of credit 565,000 246,000
Payments on line of credit (555,200) (275,000)
Payment of contingent consideration liabilities (5,710) (4,903)
Payments on capital lease obligations (53) (86)
Excess tax benefit from exercises of stock options and vesting of restricted stock and deferred stock 7,795 3,706
Proceeds from issuance of common stock 10,175 13,803
Net cash provided from (used in) financing activities 22,007 (16,480)
Net decrease in cash and cash equivalents (8,117) (6,450)
Cash and cash equivalents at beginning of period 21,280 18,596
Cash and cash equivalents at end of period $ 13,163 $ 12,146